Healthcare Provider Details

I. General information

NPI: 1134347859
Provider Name (Legal Business Name): EMMANUEL OKUDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 S WESTERN AVE
LOS ANGELES CA
90047-4458
US

IV. Provider business mailing address

13535 YUKON AVE #17
HAWTHORNE CA
90250-7664
US

V. Phone/Fax

Practice location:
  • Phone: 323-777-4227
  • Fax:
Mailing address:
  • Phone: 310-491-6692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: